Doctors Could Start Considering the Cost, as Well as the Effectiveness, of Treatments
There's a controversial debate within the medical community over whether doctors should consider the cost of a treatment as well as its effectiveness.
There's a controversial debate within the medical community over whether doctors should consider the cost of a treatment as well as its effectiveness. Supporters say doctors can't ignore the rising costs of health care, and detractors call it bedside rationing, The New York Times reports on Friday.
A task force within the American Society of Clinical Oncology announced that it "is weighing efficacy, side effects and price using an algorithm to determine the relative value of drugs," using a system that will be available for public comment, according to Bloomberg. The Times writes that the American College of Cardiology and the American Heart Association also plan to factor in cost when they rank treatments in their practice guidelines and performance standards. The result is that some doctors might choose one drug over another, which might mean savings for patients in the long run. That's what the Society of Oncology is arguing. "Cancer is one of the primary reasons families go bankrupt today,” said Gary Lyman, an oncologist and member of the task force, told Bloomberg. "We want to make sure families understand both the benefits of what we can do, and the financial impact.”
There are also doctors who think this is a horrible idea. Critics of doctors considering costs argue that deciding if some treatments are too expensive, "at the end of life, for example," noted the Times, is rationing. People who pay attention to budgets shouldn't be the same people who actually treat people, Dr. Martin A. Samuels, who chairs the neurology department at a Boston hospital, told the Times. Patients will lose trust in their doctors, he says. And there's some evidence for that: Obamacare's small attempt to cut costs within Medicare was quickly labelled a grandmother-killing death panel.
The problem is, not one else is really working on lowering costs, argue some analysts. “In some ways, it represents a failure of wider society to take up the issue,” University of Chicago professor Daniel P. Sulmasy told the Times. American health care is expensive in part because doctors are paid a lot and drugs are very expensive, as David Culter, a Harvard health economist, explained to PBS in November. Doctors are not likely to advocate for lower salaries for themselves, and they're not in a position to lower drug costs. The reason so many doctors received million-dollar payouts from Medicare in 2012 was in large part due to a $2,000 eye drug. The drug's manufacturer refuses to offer its $50 drug alternative for eye treatments. Medicare doctors also receive six percent more than the cost of the drug, meaning they benefits from using the $2,000 treatment as well.
Cheaper medicine is actually something the government could be involved in — the reason drugs are so much cheaper in other countries is because the government buys in bulk and negotiates the price down. That's the reason medicine is cheaper through government plans, though the federal government has a limited ability to negotiate prices. Vox has a series of charts showing just how much more Americans pay for the exact same treatments. Nexium costs $23 in the Netherlands and $215 in the United States. Some doctors hope that paying attention to drug costs will keep some companies from raising their prices, but we'll still be paying more than the Dutch.